应用不同入路切取股前外侧皮瓣行舌癌切除后缺损的修复重建  

Tongue reconstruction using anterolateral thigh flap obtained via different approaches

作　　者：宋达疆 李赞 周晓 池征璘[2] 侯春林[3] 

机构地区：[1]湖南省肿瘤医院中南大学湘雅医学院附属肿瘤医院肿瘤整形外科,湖南长沙410013 [2]温州医科大学医学院附属第二医院骨科医院手外科,浙江温州325027 [3]上海第二军医大学长征医院骨创伤与修复重建外科,上海200433

出　　处：《中国耳鼻咽喉颅底外科杂志》2016年第2期129-133,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：湖南省自然科学基金面上项目(13JJ5012)

摘　　要：目的探讨不同入路股前外侧皮瓣修复舌癌术后缺损的效果。方法选择舌鳞状细胞癌患者78例,依据术中舌缺损的部位及形状设计股前外侧皮瓣,分别随机采用内侧入路和外侧入路切取皮瓣,每组各39例。比较两组皮瓣切取时间及供区损伤的差别。结果内侧入路组切取皮瓣的时间明显低于外侧入路组。内侧入路皮瓣组供区阔筋膜有16例直接闭合（41%）,外侧入路全部直接闭合（100%）。所有供区皮肤直接闭合。78例股前外侧皮瓣完全成活,2例发生血管危象,探查后缓解,皮瓣完全成活。皮瓣供区愈合良好,无骨筋膜室综合征表现,未发生感染。术后随访9~28个月,舌形态良好,咀嚼、吞咽、发音功能恢复较好。供区无运动感觉功能障碍。结论应用内侧入路和外侧入路都可以安全切取股前外侧皮瓣。Objective To investigate the effect of tongue reconstruction using anterolateral thigh free flap obtained via different approaches. Methods 78 patients suffering from squamous cell carcinoma of tongue received radical resection. Their tongue defects were reconstructed using anterolateral thigh flaps via medial or lateral approaches with equal cases（ n = 39）. The results of flap harvesting time and donor site damage via both approaches were compared. Results The flap harvesting time in the medial approach group was notable shorter than that of the lateral approach group. Fascial lata was closed directly in 16 cases（ 41%） of the medial group,and in all（ 100%） of the lateral approach group. All the 78 flaps survived. Vascular crisis occurred in 2 cases,but the flaps survived thoroughly after successful exploration. All the donor sites got healed smoothly. Neither osteofascial compartment syndrome nor infection occurred. All the patients had been followed up for 9 to 28 months postoperatively. The morphology of reconstructed tongues was excellent with good function recovery of chew,swallowing and phonation. No sensory deficit or functional impairment occurred in the donor sites. Conclusion Both medial and lateral approaches can be adopted to harvest free anterolateral thigh flap safely.

关 键 词：股前外侧皮瓣 入路 皮瓣移植 舌癌 软组织缺损 

分 类 号：R782.2[医药卫生—口腔医学]